Medicare PDE & Claims Analytics Specialist

CVS Health; New Mexico; Hybrid; USD 47,000 - 112,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health is seeking a Claims PDE Analyst to review claims and PDE errors, ensuring accurate resolution for Medicare Part D. You will translate PDE data into client-ready reports, liaise with the PDE Reporting Team and other departments, and help meet CMS deadlines.

This full-time role requires strong analytics, experience with government-regulated programs, and proficiency in Excel, SQL, and Python. Expect cross-functional collaboration and a focus on data-driven improvements.

Qualifications

• 3 years minimum experience with government-regulated health programs in financial operations.
• Bachelor's degree preferred or equivalent work experience.
• Proficient in Word and Excel; SQL and Python are a plus.

Responsibilities

• Review PDE rejections and coordinate with the PDE team to ensure timely resolution.
• Coordinate the research with various departments and submit responses to external clients or Acumen according to CMS deadlines.
• Assist with weekly PDE meetings and support continuous improvement of Medicare claims data.

Skills

Medicare/Medicaid experience

SQL

Python

Education

Bachelor's degree

Tools

Acumen Outliers

Excel

Job description

CVS Health is seeking a Claims PDE Analyst to review claims and PDE errors, ensuring accurate resolution for Medicare Part D. You will translate PDE data into client-ready reports, liaise with the PDE Reporting Team and other departments, and help meet CMS deadlines.

This full-time role requires strong analytics, experience with government-regulated programs, and proficiency in Excel, SQL, and Python. Expect cross-functional collaboration and a focus on data-driven improvements.